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The Efficacy of Tranexamic Acid Versus Epsilon Amino Caproic Acid in Decreasing Blood Loss in Patients Undergoing Mitral Valve Replacement Surgery

Received: 29 January 2017     Accepted: 9 February 2017     Published: 13 April 2017
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Abstract

Open heart surgeries under cardiopulmonary bypass are associated with excessive perioperative bleeding that often requires re-exploration. Antifibrinolytics like epsilon aminocaproic acid and tranexamic acid are widely used to control bleeding. There is paucity of literature on studies to reduce blood loss and blood transfusion following mitral valve replacement surgeries. The aim of this study was to compare incidence of re-exploration, blood loss and blood transfusion following mitral valve replacement surgeries in patients who were administered either tranexamic acid or epsilon amino caproic acid. However their efficacy has not been studied in mitral valve replacement surgeries. This is a prospective, randomized, double blind study performed among sixty patients of either sex in the age group of 18 to 60 years scheduled for mitral valve replacement surgeries. They were randomly allocated into two groups, Group 1 (TA n=3O) tranexeamic acid 20 mg/kg body weight diluted in 20ml syringe over 20 min as bolus at time of induction of anaesthesia, infusion of 2mg/kg/hr started continued throughout surgery and continued till 6 hour post operatively in recovery room. Group 2 (EACA n=30) epsilon amino caproic acid 100 mg/kg body wt bolus diluted to 20 ml syringe over 20 min as bolus at time of induction of anaesthesia, infusion 20mg/kg/hr started continued throughout surgery and continued till 6 hour post operatively in recovery room. After admission to intensive care unit total blood loss, transfusion requirements during the first 24 hours and other complications were recorded. In our study we found that mean post operative blood loss in tranexamic acid group 416+47.74 (ml) which is lower than epsilon amino caproic acid group 489+42.12 (ml) that is statistically significant. 16 out of 30 patients in TA group i.e. 53.3% patients received transfusion, where as in EACA group 21 out of 30 patients i.e. 70% patients received transfusion. The total transfusion requirements, total donor unit exposure and financial cost of blood components are less in the tranexamic acid group. Prophylactic tranexamic acid effectively reduces perioperative blood loss in mitral valve replacement surgery.

Published in Journal of Anesthesiology (Volume 5, Issue 2)
DOI 10.11648/j.ja.20170502.12
Page(s) 11-18
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2017. Published by Science Publishing Group

Keywords

Epsilon Amino Caproic Acid, Mitral Valve Replacement, Post Operative Bleeding, Tranexemic Acid

References
[1] Santos ATL, Kalil RAK, Bauemann C, Pereira JB, Nesrall IA. A randomized, double-blind, and placebo-controlled study with tranexamic acid of bleeding and fibrinolytic activity after primary coronary artery bypass grafting. Brazilian Journal of Medical and Biological Research 2006; 39: 63-69.
[2] Moulton MJ, Creswell LL, Mackey ME. Re-exploration for bleeding is a risk factor for adverse outcomes after cardiac operation. Journal of Thoracic and Cardiovascular Surgery 1996; 111: 1037-1046.
[3] Hassan MK, Hasan KA, Salam ABMA, Razzak A, Ferdous S, Maruf MF, Ahmed MU, Haq N, Ahsan NAK. Effect of Tranexamic Acid after Cardiac Surgery in Children. Cardiovascular Journal. 2009; 1 (2): 189-192.
[4] Buck ML. Use of aminocaproic acid in children undergoing Cardiac Surgery and ECMO. Paediatric Pharmacotherapy 2006; 12: 1-4.
[5] Karski JM, Dowd NP, Joiner R, Carroll J, Peniston C, Bailey K et al. The effect of three different doses of tranexamic acid on blood loss after cardiac surgery with mild systemic hypothermia (32°C). J Cardiothorac Vasc Anesth 1988; 12: 642-6.
[6] Koster A, Faraoni D, Levy JH. Antifibrinolytic Therapy for Cardiac Surgery An Update. The Journal of the American Society of Anesthesiologists. 2015; 123 (1): 214-221.
[7] Singh S, Singh A. Current status of nanomedicine and nanosurgery. Anesth Essays Res 2013; 7: 237-42.
[8] Falanga A, Russo L, Tartari CJ Pathogenesis and Treatment of Thrombohemorrhagic Diathesis in Acute Promyelocytic Leukemia. Mediterr J Hematol Infect Dis. 2011; 3 (1): e2011068.
[9] Harrow JC, Daniel F, Riper V. Hemostatic effect of Tranexamic acid and Desmopressin During Cardiac Surgery. Circulation 1991; 84: 2063-2070.
[10] Shore-Lesserson L, Reich DL, Vela-Cantos F, Ammar T, Ergin MA. Tranexamic acid reduces transfusions and mediastinal drainage in repeat cardiac surgery. Anesth Analg. 1996 Jul; 83 (1): 18-26.
[11] Dowd NP, Karski JM, Cheng DC, Carroll JA, Lin Y, James RL, Butterworth J. Pharmacokinetics of tranexamic acid during cardiopulmonary bypass. Anesthesiology. 2002; 97 (2): 390-9.
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    Sanjeev Singh, Anbarasu Annamalai. (2017). The Efficacy of Tranexamic Acid Versus Epsilon Amino Caproic Acid in Decreasing Blood Loss in Patients Undergoing Mitral Valve Replacement Surgery. International Journal of Anesthesia and Clinical Medicine, 5(2), 11-18. https://doi.org/10.11648/j.ja.20170502.12

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    ACS Style

    Sanjeev Singh; Anbarasu Annamalai. The Efficacy of Tranexamic Acid Versus Epsilon Amino Caproic Acid in Decreasing Blood Loss in Patients Undergoing Mitral Valve Replacement Surgery. Int. J. Anesth. Clin. Med. 2017, 5(2), 11-18. doi: 10.11648/j.ja.20170502.12

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    AMA Style

    Sanjeev Singh, Anbarasu Annamalai. The Efficacy of Tranexamic Acid Versus Epsilon Amino Caproic Acid in Decreasing Blood Loss in Patients Undergoing Mitral Valve Replacement Surgery. Int J Anesth Clin Med. 2017;5(2):11-18. doi: 10.11648/j.ja.20170502.12

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  • @article{10.11648/j.ja.20170502.12,
      author = {Sanjeev Singh and Anbarasu Annamalai},
      title = {The Efficacy of Tranexamic Acid Versus Epsilon Amino Caproic Acid in Decreasing Blood Loss in Patients Undergoing Mitral Valve Replacement Surgery},
      journal = {International Journal of Anesthesia and Clinical Medicine},
      volume = {5},
      number = {2},
      pages = {11-18},
      doi = {10.11648/j.ja.20170502.12},
      url = {https://doi.org/10.11648/j.ja.20170502.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ja.20170502.12},
      abstract = {Open heart surgeries under cardiopulmonary bypass are associated with excessive perioperative bleeding that often requires re-exploration. Antifibrinolytics like epsilon aminocaproic acid and tranexamic acid are widely used to control bleeding. There is paucity of literature on studies to reduce blood loss and blood transfusion following mitral valve replacement surgeries. The aim of this study was to compare incidence of re-exploration, blood loss and blood transfusion following mitral valve replacement surgeries in patients who were administered either tranexamic acid or epsilon amino caproic acid. However their efficacy has not been studied in mitral valve replacement surgeries. This is a prospective, randomized, double blind study performed among sixty patients of either sex in the age group of 18 to 60 years scheduled for mitral valve replacement surgeries. They were randomly allocated into two groups, Group 1 (TA n=3O) tranexeamic acid 20 mg/kg body weight diluted in 20ml syringe over 20 min as bolus at time of induction of anaesthesia, infusion of 2mg/kg/hr started continued throughout surgery and continued till 6 hour post operatively in recovery room. Group 2 (EACA n=30) epsilon amino caproic acid 100 mg/kg body wt bolus diluted to 20 ml syringe over 20 min as bolus at time of induction of anaesthesia, infusion 20mg/kg/hr started continued throughout surgery and continued till 6 hour post operatively in recovery room. After admission to intensive care unit total blood loss, transfusion requirements during the first 24 hours and other complications were recorded. In our study we found that mean post operative blood loss in tranexamic acid group 416+47.74 (ml) which is lower than epsilon amino caproic acid group 489+42.12 (ml) that is statistically significant. 16 out of 30 patients in TA group i.e. 53.3% patients received transfusion, where as in EACA group 21 out of 30 patients i.e. 70% patients received transfusion. The total transfusion requirements, total donor unit exposure and financial cost of blood components are less in the tranexamic acid group. Prophylactic tranexamic acid effectively reduces perioperative blood loss in mitral valve replacement surgery.},
     year = {2017}
    }
    

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    AB  - Open heart surgeries under cardiopulmonary bypass are associated with excessive perioperative bleeding that often requires re-exploration. Antifibrinolytics like epsilon aminocaproic acid and tranexamic acid are widely used to control bleeding. There is paucity of literature on studies to reduce blood loss and blood transfusion following mitral valve replacement surgeries. The aim of this study was to compare incidence of re-exploration, blood loss and blood transfusion following mitral valve replacement surgeries in patients who were administered either tranexamic acid or epsilon amino caproic acid. However their efficacy has not been studied in mitral valve replacement surgeries. This is a prospective, randomized, double blind study performed among sixty patients of either sex in the age group of 18 to 60 years scheduled for mitral valve replacement surgeries. They were randomly allocated into two groups, Group 1 (TA n=3O) tranexeamic acid 20 mg/kg body weight diluted in 20ml syringe over 20 min as bolus at time of induction of anaesthesia, infusion of 2mg/kg/hr started continued throughout surgery and continued till 6 hour post operatively in recovery room. Group 2 (EACA n=30) epsilon amino caproic acid 100 mg/kg body wt bolus diluted to 20 ml syringe over 20 min as bolus at time of induction of anaesthesia, infusion 20mg/kg/hr started continued throughout surgery and continued till 6 hour post operatively in recovery room. After admission to intensive care unit total blood loss, transfusion requirements during the first 24 hours and other complications were recorded. In our study we found that mean post operative blood loss in tranexamic acid group 416+47.74 (ml) which is lower than epsilon amino caproic acid group 489+42.12 (ml) that is statistically significant. 16 out of 30 patients in TA group i.e. 53.3% patients received transfusion, where as in EACA group 21 out of 30 patients i.e. 70% patients received transfusion. The total transfusion requirements, total donor unit exposure and financial cost of blood components are less in the tranexamic acid group. Prophylactic tranexamic acid effectively reduces perioperative blood loss in mitral valve replacement surgery.
    VL  - 5
    IS  - 2
    ER  - 

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Author Information
  • Department of Anaesthesia and Intensive Care, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

  • Department of Cardiac Anaesthesia, NHIMS, Bangalore, Karnataka, India

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